Patient Safety & Quality
SR | Interventions to reduce repetitive ordering of low-value inpatient laboratory tests
27 Mar, 2023 | 13:22h | UTC
Study reveals overuse of surveillance colonoscopy in older adults with limited life expectancy
23 Mar, 2023 | 13:11h | UTCSummary: This study investigated the association between estimated life expectancy, surveillance colonoscopy findings, and follow-up recommendations among older adults. The study utilized data from the New Hampshire Colonoscopy Registry and included adults over 65 who underwent colonoscopy for surveillance after prior polyps.
Life expectancy was estimated using a validated prediction model and categorized into three groups: less than 5 years, 5 to less than 10 years, and 10 or more years.
Out of the 9,831 adults included in the study, 8% had advanced polyps or CRC. Among the 5,281 patients with available recommendations, 86.9% were advised to return for a future colonoscopy. Surprisingly, 58.1% of older adults with less than 5 years of life expectancy were also recommended to return for future surveillance colonoscopy.
The study concluded that many older adults with limited life expectancy are still recommended for future surveillance colonoscopy. This data could help refine decision-making about pursuing or stopping surveillance colonoscopy in older adults with a history of polyps.
Article: Association of Life Expectancy With Surveillance Colonoscopy Findings and Follow-up Recommendations in Older Adults – JAMA Internal Medicine (link to abstract – $ for full-text)
JAMA Patient Page: What Should I Know About Stopping Routine Cancer Screening?
Commentary on Twitter
Findings suggest that recommending against future surveillance colonoscopy in older adults with low-risk colonoscopy findings and/or limited life expectancy should be considered more frequently than is currently practiced. https://t.co/7jKpYyuZON
— JAMA Internal Medicine (@JAMAInternalMed) March 13, 2023
Survey | Perspectives of patients about immediate access to test results through an online patient portal
23 Mar, 2023 | 13:02h | UTCSummary: This study aimed to assess patient and caregiver attitudes and preferences related to receiving immediately released test results through an online patient portal.
In a survey of 8,139 respondents across 4 US academic medical centers, 95,7% of patients preferred to receive immediately released test results through an online patient portal, even if their healthcare practitioner had not yet reviewed the result. However, 7.5% of respondents reported that reviewing results before being contacted by a healthcare practitioner increased worry. This worry was more common among respondents who received abnormal results (16.5%) compared to those whose results were normal (5%).
The authors concluded that balancing patients’ expectations of immediate access to their information with the need to manage increased worry and healthcare practitioner burden is important as healthcare systems navigate this new era of health information transparency.
News Release: Patients prefer immediate access to medical test results online, even if it’s bad news – UT Southwestern Medical Center
Commentary from one of the authors on Twitter
Do patients prefer immediate access to test results, even when the news may not be good?
Multi-site survey of 8,139 patients says: YES ✅
Patients overwhelmingly supported receiving results immediately…But WHY does this matter?? https://t.co/KSD5qOJKdd#hcldr #healthIT pic.twitter.com/vz8DYBlVu7
— Liz Salmi (@TheLizArmy) March 21, 2023
Regular measurement is essential but insufficient to improve quality of healthcare
23 Mar, 2023 | 12:33h | UTCRegular measurement is essential but insufficient to improve quality of healthcare – The BMJ
Service delivery redesign is a process, not a model of care
23 Mar, 2023 | 12:32h | UTCService delivery redesign is a process, not a model of care – The BMJ
Analysis | Networks of care to strengthen primary healthcare in resource constrained settings
21 Mar, 2023 | 13:08h | UTCNetworks of care to strengthen primary healthcare in resource constrained settings – The BMJ
White Paper | Best practices in the communication and management of actionable incidental findings in ED imaging
20 Mar, 2023 | 13:34h | UTC
Critical care outreach teams: a service without walls
20 Mar, 2023 | 13:27h | UTCCritical care outreach teams: a service without walls – Intensive Care Medicine
Commentary on Twitter
Critical care outreach teams
? unanswered questions
? future directions
Early recognizing deterioration/implementing time-critical interventions save lives! CCOTs offer holistic, supportive approach pre/post #ICU, beyond clinical assessment.#FOAMcc
?️ https://t.co/s9F9v25cNO pic.twitter.com/5uwPvZ04Ye— Intensive Care Medicine (@yourICM) March 18, 2023
Review | Evidence-based informed consent form for total knee arthroplasty
17 Mar, 2023 | 12:58h | UTC
Advantages and challenges of using telehealth for home-based palliative care | Systematic mixed studies review
16 Mar, 2023 | 13:14h | UTC
M-A | Low-intensity follow-up after cancer surgery does not reduce patient satisfaction or well-being
16 Mar, 2023 | 13:10h | UTCOncological surgery follow-up and quality of life: meta-analysis – British Journal of Surgery
Scanxiety among adults with cancer: a scoping review to guide research and interventions
14 Mar, 2023 | 13:55h | UTCSummary: The article presents a scoping review of existing literature on scanxiety, which refers to the anxiety and distress experienced by cancer patients before and after medical imaging scans. The authors identified and synthesized findings from 36 articles on scanxiety among adults diagnosed with current or prior cancer.
The authors observed that scanxiety is a prevalent issue throughout the cancer continuum and may be linked to various factors related to the procedure itself or the uncertainty surrounding the possible outcomes of the scans.
The waiting period between the scan procedure and receipt of the results was described as particularly stressful, with participants reporting feeling overwhelmed by negative thoughts and fears about the potential outcomes of the scan. Some participants even found it difficult to focus on daily activities or responsibilities during this time.
The authors suggest that implementing supportive measures during scan experiences, including examining the waiting period between scans and scan results, could enhance the well-being for individuals with cancer who are going through different stages of treatment.
Article: Scanxiety among Adults with Cancer: A Scoping Review to Guide Research and Interventions – Cancers
SR | Environmental interventions can reduce falls in high-risk older adults
14 Mar, 2023 | 13:58h | UTCSummary: Falls and fall-related injuries are common among older adults and can have serious consequences, such as restricting activity or institutionalization. The Cochrane review aimed to assess the effects of environmental interventions, such as fall-hazard reduction, assistive technology, home modifications, and education, on preventing falls in older adults living in the community.
The review included 22 randomized controlled trials from 10 countries involving 8,463 community-residing older people. The study found that home fall-hazard interventions, which involve evaluating potential fall hazards and implementing safety adaptations or behavioral strategies, can reduce the rate of falls by 26% and the number of people who experience one or more falls by 11% in people at a higher risk of falling.
On the other hand, the study did not find any evidence of a decrease in the rate of falls when the interventions were not targeted toward individuals at higher risk. Additionally, the study suggests that these interventions are unlikely to have a significant impact on health-related quality of life, and there may be little or no difference in the risk of fall-related fractures, hospitalizations due to falls, or the rate of falls that require medical attention.
Summary: Reducing fall hazards within the environment – Cochrane Library
Commentary: Preventing falls in older people: new evidence on what helps – Evidently Cochrane
Hospitalist comanagement reduces patients’ length of stay and improves oncologist experience, preliminary evidence suggests
13 Mar, 2023 | 14:33h | UTCOutcomes on an inpatient oncology service after the introduction of hospitalist comanagement – Journal of Hospital Medicine (link to abstract – $ for full-text)
News Release: Involving hospitalists in inpatient cancer care reduces patient stays, oncologist stress – Yale School of Medicine
Perspective | Diagnostic stewardship to prevent diagnostic error
6 Mar, 2023 | 14:18h | UTCDiagnostic Stewardship to Prevent Diagnostic Error – JAMA (free for a limited period)
Commentary on Twitter
This #Viewpoint discusses diagnostic stewardship and its uses and challenges in preventing diagnostic error. https://t.co/VtiqHsrlwU pic.twitter.com/Q0VVOPCrF2
— JAMA (@JAMA_current) March 2, 2023
An overview of systematic reviews and meta-analyses on the effect of medication interventions targeting polypharmacy for frail older adults
3 Mar, 2023 | 14:07h | UTCSummary: This overview of published systematic reviews examined the effectiveness of medication reviews on managing polypharmacy in frail older adults. The overview identified 10 systematic reviews, which included 154 studies. Medication reviews were the most common intervention, and the evidence suggests that they help reduce inappropriate medication use in frail older adults, but their impact on frailty scores and hospital admission is unclear. Pharmacist-led medication interventions were the most common, reducing inappropriate prescriptions in various settings. Tools, such as clinical decision-making computer support tools, were also found to be effective. The evidence quality ranged from moderate to critically low, highlighting the need for further research to establish if interventions directed at polypharmacy could have an impact on frailty syndromes.
Related:
RCT | A deprescribing intervention reduced medication burden among older adults in post-acute care
Deprescribing proton pump inhibitors – Australian Journal of General Practice
Antihypertensive Deprescribing in Older Adults: a Practical Guide – Current Hypertension Reports
Deprescribing in Palliative Cancer Care – Life
Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review – Kidney360
Polypharmacy Management in Older Patients – Mayo Clinic Proceedings
Eliminating Medication Overload: A National Action Plan – Lown Institute
Common ED Medication Errors: Polypharmacy – emDocs
Current and future perspectives on the management of polypharmacy – BMC Family Practice
Polypharmacy—an Upward Trend with Unpredictable Effects – Deutsches Ärzteblatt international
Clinical Consequences of Polypharmacy in Elderly – Expert Opinion on Drug Safety
Physicians are more burned out than ever — here’s what can be done about it
28 Feb, 2023 | 13:57h | UTCPhysicians Are More Burned Out Than Ever—Here’s What Can Be Done About It – JAMA (free for a limited period)
Related Report: Addressing Health Worker Burnout – The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Related:
AAP Clinical Report | Physician health and wellness.
M-A | Physicians suffering burnout are twice as likely to be involved in patient safety incidents.
Systematic Review | Predictors of burnout among healthcare providers.
Physician Well-being 2.0: Where Are We and Where Are We Going? – Mayo Clinic Proceedings
Assessment of Risk Factors for Suicide Among US Health Care Professionals
Beyond Burnout: Docs Decry ‘Moral Injury’ From Financial Pressures of Health Care
Hospital administration response to physician stress and burnout – Journal of Hospital Practice
Opinion: It’s Time to Talk About Physician Burnout and Moral Injury
Systematic Review: Effect of Organization-Directed Workplace Interventions on Physician Burnout
The 3 Causes Of Physician Burnout (And Why There’s No Simple Solution) – Forbes
Physician Burnout: A Global Crisis
The Burnout Crisis in American Medicine – The Atlantic
Physician burnout costs up to $17B a year, task force says – HealthcareDive
Systematic Review: Prevalence of Burnout Among Physicians
Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction
Fatal accident calls MRI safety standards into question—are more regulations needed?
28 Feb, 2023 | 13:44h | UTC
Perspective | Beware of overdiagnosis harms from screening, lower diagnostic thresholds, and incidentalomas
27 Feb, 2023 | 13:18h | UTCSummary: This article discusses the concept of overdiagnosis and its relevance to clinical practice guidelines. Overdiagnosis is the diagnosis of a condition that, if unrecognized, would not result in symptoms or cause a patient harm during their lifetime, such as discovering a low-grade cancer that will never lead to symptoms at the end of life. But, unlike false positives, overdiagnosed individuals truly have the condition; they just don’t benefit from the diagnosis. Overdiagnosis can also result from lowering diagnostic thresholds for diagnosing a disease, which inflates diagnosis rates among patients and leads to recommendations for subsequent interventions without clear benefits. The article highlights the importance of providing accurate information to patients about the possibility and burden of overdiagnosis to inform shared decision-making and minimize the harms of screening interventions.
Related:
Overdiagnosis: it’s official – The BMJ
Overdiagnosis: what it is and what it isn’t – BMJ Evidence Based Medicine
Overdiagnosis across medical disciplines: a scoping review – The BMJ Open
Too much medical care: bad for you, bad for health care systems – STAT News
Overdiagnosis: causes and consequences in primary health care – Canadian Family Physician
Five warning signs of overdiagnosis – The Conversation
What is overdiagnosed cancer? And why does it matter? – Croakey
Blame rising cancer overdiagnosis on ‘irrational exuberance’ for early detection – STAT
A food allergy epidemic… or just another case of overdiagnosis?
An epidemic of overdiagnosis: Melanoma diagnoses sky rocket
Innovative models of healthcare delivery: an umbrella review of reviews
27 Feb, 2023 | 12:37h | UTCInnovative models of healthcare delivery: an umbrella review of reviews – BMJ Open
Cluster RCT | Effect of an antibiotic stewardship intervention to improve antibiotic prescribing for suspected UTI in older adults
24 Feb, 2023 | 13:58h | UTCSummary: The study evaluated the effectiveness of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections (UTI) in frail older adults. The study was a pragmatic, parallel, cluster-randomized controlled trial conducted in four European countries and included 1041 frail older adults aged 70 or older. The intervention involved a decision tool for appropriate antibiotic use, supported by a toolbox with educational materials. The control group provided care as usual. The primary outcome was the number of antibiotic prescriptions for suspected UTI per person year, and secondary outcomes included incidence of complications, hospital referrals, admissions, and mortality. The results showed that the intervention group had a lower rate of receiving an antibiotic prescription for a suspected UTI (0.27 per person year) compared to the control group (0.58 per person year), with no increase in complications or adverse events.
Commentary: Trial: Stewardship intervention cuts antibiotic prescribing for suspected urinary infections – CIDRAP
Related:
Case-Control Study | Current pyuria cut-offs may promote inappropriate UTI diagnosis in older women
USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults
M-A | Global and regional prevalence of multimorbidity in the adult population in community settings
22 Feb, 2023 | 12:47h | UTCSummary: The article presents a systematic review and meta-analysis of surveys that estimate the prevalence of multimorbidity among adults in community settings. The study analyzed data from 126 peer-reviewed studies, including nearly 15.4 million people from 54 countries worldwide. The overall global prevalence of multimorbidity was 37.2%, with South America having the highest prevalence, followed by North America, Europe, and Asia. The study also found that females have a higher prevalence of multimorbidity than males, and that more than half of the adult population worldwide above 60 years of age had multimorbid conditions.
Related:
Costs of multimorbidity: a systematic review and meta-analyses – BMC Medicine
Systematic review of high-cost patients’ characteristics and healthcare utilization – BMJ Open
Multimorbidity: a priority for global health research – The Academy of Medical Sciences
The global burden of multiple chronic conditions: a narrative review – Preventive Medicine Reports
Redesigning Care for High-Cost, High-Risk Patients – Harvard Business Review
Multimorbidity: clinical assessment and management – NICE Guideline
Richard Smith: The challenge of high need, high cost patients – The BMJ Blogs
Better Care for People with Complex Needs – Institute for Healthcare Improvement
Gadolinium nanoparticles detected in kidney tissue of patients after MRI with gadolinium contrast, raising safety concerns
20 Feb, 2023 | 12:24h | UTCSummary: Researchers have discovered that tiny particles of the rare earth metal gadolinium can infiltrate kidney cells, potentially causing side effects. These particles, used to enhance MRI scans, were found in human and rodent specimens in a study that used electron microscopy to detect them. Gadolinium is typically tightly bound to chelating molecules in MRI contrast agents so that it can be eliminated via the kidneys, but the researchers found that some particles can leach out and build up in tissues. This raises questions about the safety of contrast agents containing gadolinium, which are used in around 50% of MRI scans, and highlights the need for further research into the risks and potential harms associated with these agents.
Commentary: Expert left ‘astounded’ by gadolinium discovery – Health Imaging
Digital health interventions for adult patients with cancer evaluated in randomized controlled trials: scoping review
16 Feb, 2023 | 14:45h | UTC
Editorial | Top-down and bottom-up approaches to low-value care
15 Feb, 2023 | 16:08h | UTCTop-down and bottom-up approaches to low-value care = BMJ Quality & Safety
Original Study: Evaluation of the NHS England evidence-based interventions programme: a difference-in-difference analysis – BMJ Quality & Safety
Commentary on Twitter
In this editorial, @andreapatey & @christinesoong discuss combining top-down ⬇️ and bottom-up ⬆️ approaches to effectively de-implement and reduce low-value care. https://t.co/mYJHkkJpSk
— BMJ Quality & Safety (@BMJ_Qual_Saf) February 10, 2023